Vertebrogenic lumbodynia: description of the disease and treatment methods

Lumbodynia or chronic lower back pain is not uncommon. For example, in the United States, low back pain is the second most common neurological ailment after headaches. Often, chronic low back pain leads to long-term loss of ability to work, and in a certain percentage of cases, to disability. As a rule, acute lower back pain is most often caused by injury or inflammation (arthritis) and lower back pain usually lasts from several days to several weeks. Acute pain can also be caused by pathology of the internal organs and be of a reflected nature. Some acute pain syndromes can lead to serious complications if not properly treated.

Chronic low back pain is pain that lasts more than 12 weeks (3 months). Chronic lower back pain can progress and sometimes it is not possible to find out the true cause of lower back pain.

Lumbodynia: types, symptoms, treatment

Lumbodynia is chronic pain in the lumbar spine. It is not an independent disease, but only one of its symptoms. Pain that lasts more than 3 months in a row is considered chronic.

A neurologist diagnoses lumbodynia. At the MedEx Personal Medicine Clinic, you can get advice from an experienced specialist, including recommendations for diagnostic procedures and laboratory tests. During the follow-up appointment, a personal treatment plan is drawn up.

Lumbodynia - the first signs of osteochondrosis

Lumbodynia syndrome (low back pain) is often the first clinical sign of osteochondrosis of the lumbar spine. Lumbar osteochondrosis of the initial stage in almost half of the cases manifests itself as subacute or chronic lumbodynia.

What causes lumbodynia

Lower back pain can occur after physical activity, lower back injury, hypothermia, and stress. But in some cases, the lower back does not begin to hurt immediately. Sometimes it takes days, weeks or even months before pain occurs.

At first, very mild lumbodynia may appear. Some patients note that their pain developed slowly and for no apparent reason. But this does not mean at all that there was no provoking factor. It’s just that this factor is not always obvious.

Then the lower back pain may intensify. Most often this happens gradually. But the pain usually does not reach the same degree of severity as lumbar pain - lumbago (acute lumbodynia). Patients walk independently and do certain work, although it is difficult for them to bend, but even more difficult for them to straighten up. At the same time, they often place their hand on the lower back, rubbing or massaging it a little. And only after that they can straighten up. Such people try to sit with a straight back.

Causes of the disease

There are many causes of lumbodynia: lower back pain can be associated with diseases or injuries of bones, muscles, and nerves. In addition, pain in this area is characteristic of many infections of the genitourinary system, pelvic organs, and abdominal organs.

Most likely:

• Spondylosis is a pathological change in the spine that leads to hardening or fixation of the vertebrae. Pain occurs due to bone growths that put pressure on the nerve structures.
• Spinal canal stenosis. Degenerative changes in the spine, accompanied by pathological narrowing of its canal. Most often found in older and older people.
• Intervertebral disc herniation. Disc fragments bulge or prolapse into the spinal canal, causing rupture of the annulus fibrosus and irritation of nearby nerve structures.
• Osteochondrosis. Degenerative-dystrophic changes in the spine, especially its lumbosacral region.
• Root compression. Compression of the nerve roots by nearby tissues is accompanied by severe pain.
• Inflammatory diseases of the spine. Accompanied by stiffness and pain, especially noticeable immediately after waking up.
• Shingles. The viral form of the disease leads to nerve damage, which results in chest or lower back pain.
• Diseases of the inflammatory system. Lower back pain can be caused by traumatic bleeding, urolithiasis and kidney infections.

Often, lumbodynia develops during pregnancy. This is due to changes in the hormonal levels of the expectant mother, which affects the condition of bone structures and ligaments. In addition, due to the position of the child inside the abdominal cavity, the natural curvature of the spine is disrupted.

How does chronic vertebrogenic lumbodynia occur?

Low back pain with osteochondrosis is characterized by periods of remissions and exacerbations. Sometimes remissions are quite long, several years. It may seem that recovery has arrived. However, real recovery is not always observed. If the spine continues to work incorrectly, with overload in the lumbar region, then the disc continues to deteriorate. And if there were no protrusions and hernias, then they may well appear. And if they already existed, then their size may increase. And lower back pain in such situations tends to get worse.

Causes of exacerbation of vertebrogenic lumbodynia

Intensification or recurrence of pain occurs under the influence of various mechanical and traumatic factors, hypothermia, and stress. The proportion of hypothermia as a factor provoking exacerbation of lumbodynia is significantly greater than the causes of the primary occurrence.

Pathological processes occurring outside the spine affect the reactivity of the body in general. But they can also influence the course of lumbar osteochondrosis in particular. Chronic somatic diseases, foci of local infection, as a rule, aggravate the course of lumbodynia.

Also, the development of osteochondrosis, the formation of protrusions and hernias of spinal discs is greatly influenced by endocrine pathology. These are diseases of the thyroid and parathyroid glands, adrenal glands and progressive diabetes mellitus.

Expert opinion

Lumbodynia can be confused with lumbago - acute pain in the lower back. There really is a lot in common between these neurological syndromes. But there are also differences.

Lumbodynia is characterized by a less intense pain syndrome. It is aching in nature, worsens in the morning, increases or decreases during the day. The pain may persist for a long period of time - more than three months.

Lumbago is a sharp pain in the lower back: it is often compared to being stabbed with a knife. It occurs suddenly, pain is felt during the first half hour of the attack, then gradually subsides.

Lumboischialgia is the name of another related set of symptoms. It manifests itself as pain in the lumbar region, radiating to the lower extremities. The name is due to the fact that the pain syndrome is accompanied by sciatica - inflammation of the sciatic nerve.

Causes of lumbodynia

Low back pain (lumbodynia), both chronic and acute, is most often caused by pathological processes (degenerative-dystrophic) in the spine, especially in the lumbar region. In addition to osteochondrosis, lumbodynia is caused by its complications, such as protrusion, spondylolisthesis, intervertebral hernia, spondyloarthrosis, spondylosis.

The mechanism of lumbodynia is based on irritation of the nerves (especially sinuvertebral). Pain is especially pronounced with cracks in the fibrous ring. Also the cause is abnormalities in the development of the lumbar spine.

Pain can occur after a single physical overload, lower back injuries, hypothermia, stress, sudden turns of the body, hypothermia, exposure to drafts, prolonged exposure to an uncomfortable or monotonous position. Moreover, lumbodynia can manifest itself not only after a few days or weeks, but even several months after the provoking factor.

The risk group also includes those who are overweight, have certain chronic diseases, have infectious diseases, workers in hazardous industries, those who experience increased stress, lead an adynamic lifestyle, or are in an uncomfortable or the same body position for a long time.

Types of lumbodynia

Depending on the location, there are left-sided, right-sided and symmetrical lumbodynia. In addition, there is a classification taking into account the cause of pain.

The most common is vertebrogenic lumbodynia. This is the name for back pain caused by a chronic form of osteochondrosis. Vertebrogenic is more common in men and can have a different duration - up to several years.

Discogenic lumbodynia is a pain syndrome caused by diseases of the intervertebral discs. Its appearance is most often caused by a hernia or protrusion.

Muscular-tonic lumbodynia is a condition in which pain intensifies due to the slightest activity: sneezing, talking, laughing. Muscular-tonic syndrome is caused by reflex tension of the lower back muscles.

More about the disease

The main cause of lower back pain is a degenerative-dystrophic process in the spine. Therefore, any pathology of the intervertebral discs, leading to compression of the spinal roots and accompanied by characteristic symptoms, is called vertebrogenic lumbodynia. According to ICD 10, the disease has code M51 , reflecting structural changes in bone tissue as a result of osteochondrosis. The diagnosis implies bringing to the fore the degenerative-dystrophic process itself, leading to pain.

The main symptoms of vertebrogenic lumbodynia are similar to those of local dorsopathy. They can be represented like this:

• pain in the lumbar region;
• irradiation of pain into the leg and buttock;
• limited mobility in the lumbar segment of the spine;
• local muscle tension in the affected area;
• gait disturbance in the form of lameness;
• changes in sensitivity and innervation of the lower extremities up to paresis or paralysis.

The main difference between vertebrogenic lumbodynia is the presence of constant irradiation, the absence of general intoxication and temperature reaction, even with significant pain.

The pain can be acute or aching, chronic, unilateral or symmetrical, and in severity - mild, moderate or severe. It always decreases at rest or when taking a comfortable position, and increases with movement. Unilateral lumbodynia - right-sided or left-sided - occurs with a local degenerative-dystrophic process with compression of the corresponding nerve root.

Acute vertebrogenic lumbodynia is characterized by the following features:

• sudden onset, often after intense physical effort;
• pronounced pain syndrome;
• the impossibility of active movements in the lower back or their serious limitation;
• pronounced irradiation into the leg, leading to the patient having to lie down;
• Despite the severity of the symptoms, the general condition remains completely satisfactory.

Acute pain is always combined with muscular-tonic syndrome. The latter is characterized by a sharp limitation of active movements in the lower back and limbs. The essence of the syndrome lies in the tension of the muscle fibers innervated by the damaged spinal root. As a result, their tone increases, which complicates the normal function of the limbs. The problem occurs more often on the right or left, but can be bilateral.

Chronic vertebrogenic lumbodynia lasts for years and decades, periodically reminding itself of painful sensations. Typical symptoms:

• aching or dull moderate pain in the lower back;
• weak irradiation into the leg, increasing with exacerbation after hypothermia or physical stress;
• muscle-tonic syndrome is slightly expressed;
• the patient remains able to work, but the degenerative-dystrophic process is steadily progressing;
• painkillers are required, but the discomfort only subside and does not go away completely.

The diagnosis of chronic lumbodynia is easily confirmed by magnetic resonance or computed tomography, where specific osteochondral changes, including herniation, are clearly visible. Treatment of the disease takes a long period of time, but the main task is to quickly relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, muscle relaxants and anxiolytics are used for this purpose.

They complement the therapeutic complex with physical. exercise and physical therapy. How to treat vertebrogenic lumbodynia with persistent pain syndrome? Typically, this situation occurs with organic stenosis of the spinal canal, which is associated with hernial protrusions. Therefore, when persistent pain persists, surgical approaches to treatment are used - from local anesthetic blockades to surgical assistance in the form of laminectomy.

Symptoms

Pain syndrome with lumbodynia can intensify or subside at different times of the day. The intensity of pain also changes with physical activity. In some patients, pain with lumbodynia becomes more pronounced during the period of activity, in others - on the contrary.

It is difficult for the patient to bend over, even with assistance. When pressing on the vertebrae and paravertebral areas in the lumbar region, pain is felt. In a lying position (usually on your side, with your legs bent), the pain subsides a little.

What is lumbodynia

Pain with lumbodynia can be chronic or acute/subacute, but in any case it is caused by spinal pathology. Lumbodynia syndrome is considered a sign of osteochondrosis of the lumbar spine, although often with this diagnosis there may be no pain at all. The severity of pain can vary and depends on the individual and a combination of a number of factors. It occurs mainly in people of working age (25-45 years).

Lumbar pain can be localized only on one side or on both (right-sided, left-sided, symmetrical). It most often worries in the lower lumbar region and can radiate to the gluteal region (one or both buttocks).

Diagnostics

Diagnosis of lumbodynia begins with an initial examination and medical history. The doctor finds out when and under what circumstances the pain syndrome occurred, and whether there are accompanying symptoms.

To clarify the diagnosis, the following studies may be prescribed:

• x-ray - to look for gross changes in bone tissue;
• MRI - to detect degenerative changes, as well as damage to muscles, nerves, ligaments, and blood vessels;
• CT scan - to determine hernia, tumor stenosis;
• Ultrasound - to visualize the abdominal cavity.

Diagnostic procedures and laboratory tests are selected taking into account the medical history and complex of symptoms.

Diagnosis of lumbodynia

Lumbodynia can be diagnosed in different ways. A neurologist diagnoses this disease. The most common is a clinical examination and questioning of the patient, combined with static and dynamic examination of the spine, as well as manual diagnostics. Additionally, the organs of the pelvic and abdominal cavities are examined to exclude diseases that are a source of referred pain. In addition, MRI, radiography, and ultrasound diagnostics will not be superfluous. During the examination, lumbodynia is differentiated from myositis of the spinal muscles and pathologies of the hip joint.

IMPORTANT! Lumbodynia is a serious symptom that can tell a person about significant problems in the lumbar spine, ranging from inflammatory phenomena to destructive diseases. That is why, if you have lumbodynia, you cannot self-medicate, but you should definitely consult a specialist!

Experienced doctors at the Kuntsevo Medical and Rehabilitation Center will conduct a thorough diagnosis and understand the causes of the symptom. A treatment plan for the patient will then be drawn up. Make an appointment with our doctor and take a step towards getting rid of lumbodynia!

Sign up

Treatment

Treatment of acute lumbodynia is medication. The doctor selects medications to quickly relieve pain and muscle spasms:

• non-steroidal anti-inflammatory drugs;
• muscle relaxants;
• antidepressants;
• opioids (short term).

During an attack of pain, novocaine injections are used. Intradermal injections aimed at eliminating pain are called novocaine blockade.

During the recovery period, physical therapy methods are actively used: manual therapy, physical therapy. The patient is selected a set of exercises, which he performs under the supervision of a doctor individually, in groups or independently. Exercise therapy strengthens the back and abdominal muscles, which is important for preventing relapses.

Acupuncture has proven itself well: it helps restore the sensitivity of nerve endings and establish the process of transmitting impulses along the nerves. It is also possible to use laser, interventional and other methods of physiotherapy.

Important! The information is posted on the website for preliminary reference. Do not self-medicate - this may worsen the course of the disease. Consult a doctor!

Treatment with manual therapy

You can get rid of lumbodynia only by eliminating the causes that caused it. This type of treatment can be considered complete. In other cases, the help will have a temporary effect and after some time, lumbodynia will appear again, and if the treatment was inadequate, it will intensify or recur. It is important to find a good chiropractor, otherwise you may not only not be cured, but even make things worse.

Since the main cause of lumbodynia is considered to be vertebral osteochondrosis, the cause of which, in turn, is improper functioning of the spine, it is not lumbodynia that should be treated, but osteochondrosis. In addition, by getting rid of osteochondrosis, you will protect yourself from the occurrence of its complications, such as hernias and disc protrusions.

Manual therapy is considered one of the most effective ways to eliminate problems in the spine. It is especially effective in combination with the subsequent implementation of a complex of physical therapy (physical therapy). All this not only improves the condition, but also stimulates recovery processes, thanks to which the course of the disease can sometimes not only be stopped, but also reversed.

The number of procedures is prescribed individually, based on the patient’s health characteristics, stage of the process, complications, and concomitant diseases. It is also necessary to perform exercise therapy to consolidate the achieved result and maintain it after treatment.

How to prevent the syndrome from occurring?

To prevent lower back pain, it is recommended to engage in fitness, paying special attention to exercises on the back muscles. Their weakness leads to increased stress on the spine, which can cause lumbago. Swimming and cycling are also suitable.

Walking and maintaining a normal weight for your height have a beneficial effect on your back.
Hypothermia is dangerous, but reasonable hardening activates the metabolism in the spine. For sleeping, you should choose special mattresses - orthopedic. They allow the body to take an anatomically correct position during rest. It is especially good to sleep on your side - in this position the spine is unloaded. When working at a computer, you need to lean on the back of your chair. It is advisable to choose models with orthopedic properties.

Spondylogenic type

Damage to the intervertebral joints and vertebral processes is the basis of spondylogenic lumbodynia. It is most often autoimmune in nature, as it is associated with systemic damage to osteochondral tissue. Discogenic lumbodynia is caused by changes in the intervertebral space due to joint deformation. This leads to damage to the spinal roots, and subsequently the sciatic nerve is involved in the process. Pain in the spine, radiating to the leg and buttock with damage to the sciatic nerve, is called “sciatica.” The typical pain syndrome is felt more in the leg, which makes even simple movements of the limb difficult.

Typical signs of spondylogenic lumbodynia of an autoimmune nature with sciatica can be presented as follows:

• severe pain in the buttock and leg;
• severe limitation of movements in the limb;
• slight low-grade fever;
• severe emotional lability of the patient;
• reaction of acute-phase blood parameters with the systemic nature of the disease;
• bilateral changes in the joints on CT or MRI examination.

The patient's vertical posture is especially difficult, but what is it? This means that the patient cannot stand in a standing position for even a few seconds due to severe pain in the leg. The problem disappears after drug stabilization of the patient's condition.

Recovery Exercises

Physical therapy is an important part of the treatment of the disease. However, before you start training, it is important to establish the causes of lumbodynia. If there is a compression fracture, then bed rest with gentle exercise is indicated. Novocaine blockade often helps with severe pain.

The full set of exercises can be viewed here:

Physical activity should be combined with other non-drug methods of assistance. Massage is especially effective for chronic pathologies. It is advisable to conduct his sessions no more than 2 times a year. Can there be a temperature with lumbodynia? This question cannot be answered unequivocally. There should not be a high temperature reaction, but a slight low-grade fever due to an autoimmune process or excessive emotional outbursts is possible.

To alleviate the condition, hormones, cytostatics and psychocorrectors are prescribed. But what antidepressants can be taken in combination with exercise? According to neurologists, there are no serious restrictions on taking these drugs. Modern antidepressants can be used long-term.

Treatment of lumbodynia

There are two periods in therapeutic measures for lumbodynia. Severe pain requires bed rest for several days, as well as intensive use of medications to alleviate the person's suffering. In the acute period, the following treatment is used:

• injections of analgesics or NSAIDs (Diclofenac, Analgin, Ketorolac);
• intravenous infusions of vasodilators (Trental);
• parenteral or oral use of muscle relaxants (usually Tolperisone);
• local anesthetic blockades or narcotic analgesics for persistent pain;
• physiotherapy - quartz or electrophoresis.

For those patients who have suffered an attack of lumbodynia, acute pain remains in their memory forever. However, therapy does not end with pain relief. It is important to take drugs that stabilize cartilage tissue - chondroprotectors. If a hernia is present, surgical correction is indicated. Of those patients who cured lumbodynia, many patients underwent laminectomy. This is a radical way to get rid of intervertebral hernia.

Lumbar pain

There are several causes of pain in the lower spine. Lumbodynia is associated with the following pathological conditions:

• degenerative-dystrophic process – spinal osteochondrosis (the most common cause);
• tumors of bone and nervous tissue localized in the lumbar region;
• cancer metastases to the spine;
• autoimmune processes – ankylosing spondylitis, rheumatoid arthritis;
• congenital anomalies of skeletal structure;
• pathology of muscle tissue - myositis or autoimmune lesions.

Since the main cause of lumbodynia is spinal osteochondrosis, the main symptoms are associated with it. Typical manifestations include:

• back pain radiating to the leg;
• classic symptoms of tension associated with muscle hypertonicity (Lasègue, Bonnet, Wasserman);
• difficulty walking;
• limited mobility in the lower back;
• pronounced emotional discomfort.

When the spine is damaged due to tumors, the pain is persistent and pronounced. They do not go away under the influence of conventional NSAIDs, and removal requires the use of narcotic analgesics. There is a clear intoxication with decreased appetite, pale skin and weight loss. In the lumbar region, especially against the background of weight loss, it is easy to notice a neoplasm that does not move during palpation and is dense to the touch.

With chronic damage to the spine, the symptoms are not too pronounced if the process is in remission. However, it progresses steadily, which, against the background of cooling or intense exercise, leads to exacerbation. Chronic lumbodynia during this period differs little from an acute pain attack. But due to the fact that the disease lasts a long time, treatment is delayed and sometimes requires surgical correction. Lumbodynia often occurs during pregnancy, which is due to the increased load on the spine. However, due to the negative impact of many medications on the fetus, treatment has its own nuances and difficulties.

The table below presents treatment options for back pain in various clinical situations.

The spondylogenic nature of spinal lesions is associated with autoimmune diseases. Most often it is ankylosing spondylitis, less often - dermatomyositis or rheumatoid arthritis. Treatment is usually conservative, and pain can be relieved using the combined effects of NSAIDs and cytostatics. With maintenance use of immunosuppressants, the disease progresses in a stable manner with steady progression, but with long-term disability. Treatment with folk remedies gives only a temporary effect due to the irritating effect of plant materials. However, such therapy is not capable of affecting osteochondral tissue. Therefore, the passion for folk remedies is destructive, especially with autoimmune or malignant lesions of the spine.

Exercises for lumbodynia have a good effect in relieving pain and quickly restoring movements. Their effect is most pronounced during the degenerative-dystrophic process, as well as during recovery after surgery. Exercises used for vertebrogenic lumbodynia:

• arm and leg lunges . Starting position: standing on all fours. The essence of the exercise is to simultaneously straighten the leg and arm on the opposite side. The duration of the lesson is at least 15 minutes;
• circular movements . Starting position - lying on your back, feet shoulder-width apart, and hands pressed to the body. The essence of the training: alternately raising the lower limbs to a height of up to 15 cm and performing rotational movements. The exercise is done at a slow pace. The duration of the lesson is at least 10 minutes;
• bridge _ Classic exercise for osteochondrosis. Its essence is to lift the pelvis using the strength of the muscles of the limbs, with emphasis on the feet and elbows. Duration of training - at least 10 minutes;
• leg girth . Starting position - lying on your back, legs extended at all joints, arms along the body. The essence of the exercise: you need to bend both lower limbs at the knee and hip joints, and lift your body to reach out with your arms and clasp your hips. Number of repetitions – at least 15 per day;
• tilts _ The exercise is useful for strengthening the muscular corset of the back during a subsiding exacerbation or remission. During periods of severe pain, it is better to refuse to perform it. The essence of the training is to bend your torso from a standing position and try to reach your feet or the floor with your hands. The number of repetitions is at least 15 times a day.

Physical exercise cannot be the only alternative to treating a patient. They are effective only in combination with medication support or surgical correction.

Objective state of lumbodynia

When examining patients with lumbodynia, pain in the paravertebral points and spinous processes of the vertebrae is determined. Symptoms of tension are mild or moderate. Positive symptom of Lasegue, less often positive symptoms of Neri, Wasserman, Matskevich, Dejerine. Motor disturbances and changes in tendon-periosteal reflexes are often absent. There is no loss of sensitivity. When the thoracic spine is involved in the pathological process, doctors talk about thoracolumbodynia.